Provider Demographics
NPI:1982764304
Name:HERZMAN, JAMES S JR (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:HERZMAN
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5961 S LOS ALTOS PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-2501
Mailing Address - Country:US
Mailing Address - Phone:775-359-2020
Mailing Address - Fax:775-359-2676
Practice Address - Street 1:1987 N CARSON ST STE 5
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-1225
Practice Address - Country:US
Practice Address - Phone:775-883-2015
Practice Address - Fax:775-883-5805
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV343 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1982764304Medicaid
NV1326351925Medicaid
NV1063727709Medicaid
88-0456539OtherTAX ID NUMBER
NVV37415Medicare PIN
NVBT808AMedicare PIN